| NPI | 1790081032 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BONNIE S WILSON President 208-818-1411 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: ID NP-999A) |
| Enumeration Date | 2011-02-03 |
| Last Update Date | 2013-07-05 |